Prediction of the prognosis in patients with acute-on-chronic hepatitis using the MELD scoring system


Dr Shu-Chen Li, Department of Infectious Diseases, The Second Affiliated Hospital, Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin 150086, China.


Aim:  To predict prognosis in patients with acute-on-chronic hepatitis (AOCH) using the model for end-stage liver disease (MELD) scoring system and to study the effects of age, sex, etiology, low serum sodium, and persistent ascites on MELD.

Methods:  The MELD scores of 300 patients with AOCH were calculated according to the original formula. The 3-month mortality in patients was measured, and the validity of the models was determined by means of the concordance (c) statistic. The influential factors on MELD were also assessed.

Results:  The 3-month mortality of AOCH patients with a MELD score of 20–29 was 56.0%, with a score of 30–39 it was 76.5%, and with a score over 40 it was 98.2%. The concordance (c) statistic of 3-month mortality was 0.782. Univariate analysis showed that mortality was significantly related to age (P = 0.047), etiology (P = 0.039), serum sodium (P = 0.029) and ascites (P = 0.031) for patients with MELD scores 20–29. In multivariate analysis, in patients with MELD scores 20–29, age (P = 0.012), etiology (P = 0.024), serum sodium (P = 0.005) and ascites (P = 0.017) were independent predictors of mortality; for MELD scores above 30, only MELD score (P = 0.015) was independently predictive.

Conclusions:  The MELD scoring system is a reliable method for predicting mortality in patients with AOCH. In the group with MELD score 20–29, factors including age, etiology, presence of low serum sodium and persistent ascites may influence the MELD scoring system. The MELD score is the decisive predictor of the prognosis of patients with AOCH when the MELD score is over 30.